Healthcare Provider Details

I. General information

NPI: 1972144855
Provider Name (Legal Business Name): TRACI RIZZO MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24715 LITTLE MACK AVE STE 200
SAINT CLAIR SHORES MI
48080-3207
US

IV. Provider business mailing address

22198 28 MILE RD
RAY MI
48096-3227
US

V. Phone/Fax

Practice location:
  • Phone: 586-777-9000
  • Fax: 586-777-0823
Mailing address:
  • Phone: 586-777-9000
  • Fax: 586-777-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025029451
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: